Nursing staff member experiences with household model implementation in a nursing home setting.

This qualitative study used conventional content analysis of interview data to examine nursing staff members' experiences with Household Model implementation in a nursing home setting. Staff members were recruited from the skilled nursing center post implementation and completed individual interviews (N=16). Participants described the impact of implementation in relation to three categories: antecedents, explicit reactions and change consequences. Participants described barriers and facilitators to implementation as well as outcomes such as role strain, feelings of isolation and harder working conditions. This study provides opportunities for further examination of nursing staff members' experiences with person centered care models in nursing homes, how those experiences may relate to effectiveness of implementation and the need for support of nursing home staff.

Effects of Teaching Evidence-Based Medicine on Physician Assistant Students' Critical Appraisal, Self-Efficacy, and Clinical Application: A Randomized Controlled Trial.

PURPOSE: To use a randomized controlled design to explore the effects of evidence-based medicine (EBM) education on physician assistant (PA) students' EBM knowledge, self-efficacy, and evidence-seeking behavior in a simulated clinical situation and to present a model of EBM competence. METHODS: Sixty-one didactic-year PA students from one Midwestern University (2 sequential cohorts) were randomized to receive the standard PA curriculum plus EBM training (intervention) or the standard PA curriculum only (control). Evidence-based medicine knowledge was measured with a validated Fresno test. Self-efficacy was measured with a validated Likert scale. Clinical application of EBM skills was measured with an objective structured clinical examination (OSCE). RESULTS: Evidence-based medicine education led to significant improvements on the Fresno and self-efficacy tests, both within and between groups. On the OSCE, the intervention group performed no better than the control group. Higher Fresno pretest scores were significantly related to decreasing improvements in the posttest scores: R = -0.634. CONCLUSION: Teaching EBM to PA students improved their EBM knowledge and self-efficacy but not their clinical application. Future research should focus on enhancing EBM evaluation and application in the clinical setting.

Environmental Health Program Performance and its Relationship with Environment-Related Disease in Florida.

This study used a unique approach to examine Florida county health department environmental health (EH) program performance of the 10 Essential Environmental Public Health Services (EEPHS) and its relationship with environment-related disease, described by enteric disease rates. Correlation analysis tested the association between performance of each EEPHS and five different enteric disease rates, while multivariate regression analysis further examined the relationships while considering program organizational characteristics as potential confounders. Correlation analyses revealed cryptosporidiosis was associated with EEPHS 2 diagnose (Tb = .195, p = .027) and EEPHS 8 workforce (Tb = .234, p = .006), and salmonellosis with EEPHS 4 mobilize (Tb = .179, p = .042) and EEPHS 6 enforce (Tb = .201, p = .020). Multivariate regression results showed EEPHS 2 diagnose (p = .04) and EEPHS 4 mobilize (p = .00) had statistically significant associations with cryptosporidiosis and salmonellosis, respectively, and suggested that improved performance of these two EEPHS may have decreased disease incidence. EH programs may benefit from improving the performance of EEPHS to address the incidence of certain enteric diseases. Continued efforts to develop a robust understanding of EH program performance and its impact on environment-related disease could enhance EH services delivery and ability to improve health outcomes.

An analysis of theme content in CASPA personal statements.

PURPOSE: Personal statements are a required component of the Central Application Service for Physician Assistants (CASPA) application package submitted to physician assistant (PA) programs that participate in the service. Prior research involving the use of personal statements in the selection process of graduate and professional programs has found a significant amount of homogeneity within the statements. This study sought to determine the major theme content and frequency of occurrence of these themes in the personal statements submitted by applicants to a Midwestern PA program. METHODS: After receiving signed consent, personal statements were extracted from the application packages of 63 students. Statements were identified with a random number. Each statement was reviewed and content themes were identified and manually coded by two separate reviewers. The reviewers and primary investigator then met and determined the major content categories by consensus. RESULTS: The review identified seven major content themes. Four of these themes were present in 70% or more of the statements: health care experience, altruism, patient interaction, medical profession. CONCLUSION: The personal statements reviewed contained similar content, confirming prior research that these statements may follow some formula for success. This may be evidence that applicants feel these attributes demonstrate that they are qualified candidates for admission. Further study should be conducted to see how these statements are used in the PA program admissions process.

Understanding the motivations of the multigenerational physician assistant workforce.

Physician assistants (PAs) are more frequently finding themselves in positions where they are responsible for staff recruitment and retention. Staff turnover is associated with significant financial costs for organizations. Motivational theories focusing on job design indicate that paying attention to a combination of factors related to the work itself, in addition to the environment where the work is performed, increases satisfaction. This study asked a convenience sample of practicing PAs to rate the importance of a number of work-related factors known to influence job satisfaction. The results may be used as a basis for designing an environment to increase job satisfaction and improve recruitment and retention of highly qualified staff.

Quality outcomes among efficient and inefficient nursing homes: a national study.

BACKGROUND: With an anticipated increased use of nursing homes to serve an aging population in the United States, questions regarding the quality and cost of nursing home services come to the fore. Such questions are the concern of nursing home residents, their families, private and public payers, policy makers, regulators, and nursing home operators. PURPOSES: The purpose of this study was to examine the relationship between quality of care and efficiency of nursing homes to determine the characteristics of facilities that achieve high quality and high efficiency. The study sought also to determine the extent to which nursing homes can provide high-quality services and do so with a high level of efficiency. METHODOLOGY/APPROACH: This was a cross-sectional study of a 10% random sample of U.S. nursing homes, excluding those in hospitals and also those with fewer than 20 beds or more than 360 beds. Data sources were the Online Survey Certification and Reporting, the Area Resource File database, the U.S. Bureau of Labor Statistics, and the U.S. Bureau of Economic Analysis. Data envelopment analysis was employed in the analysis of data. FINDINGS: The average efficiency of nursing homes was 0.869 (SD = 0.1362), with a statistically significant higher average efficiency for nursing homes in urban areas; in counties with a higher level of competition, higher average income, or higher number of home health agencies; and in not-for-profit and governmental facilities. Quality measures were compared between efficient and inefficient nursing homes, showing mostly favorable quality outcomes for efficient nursing homes. PRACTICE IMPLICATIONS: Families and residents evaluating or in search of nursing homes can be confident that high-quality, efficient nursing homes exist. Legislators, policy makers, regulators, payers, and administrators can be confident that the setting of standards that encourage striving for both quality and efficiency simultaneously is indeed realistic.